Yukiyo Aiko

Polychlorinated biphenyls (PCBs) decrease the placental syncytiotrophoblast volume and increase Placental Growth Factor (PlGF) in the placenta of normal pregnancy

INTRODUCTION Polychlorinated biphenyls (PCBs) are a class of biologically active, highly stable compounds. Exposure risks include consumption of fatty fish, meat, dairy products and human breast milk, as well as environmental and occupational settings. Numerous reports have described PCB-dependent adverse effects on human fetal growth, including increased risk for IUGR, changes in endocrine function and hormone metabolism, and immunosuppressive and neurological deficits. Here we test the prediction that in utero PCB exposure adversely effects placental morphology, potentially leading to placental insufficiency en route to fetal growth restriction. METHODS PCB homologs (10) were measured in the maternal and fetal blood of a small cohort of normotensive pregnancies (22) by gas chromatography-mass spectrometry. PCB levels were compared with angiogenesis associated proteins Placental Growth Factor (PlGF) and sFlt-1, determined by ELISA, and the total estimated syncytiotrophoblast (ST) volume. RESULTS Significant associations between PCB exposure and both PlGF and ST volume were identified. DISCUSSION PCB effects on placenta morphology and predicted function are discussed. CONCLUSION These results demonstrate that the human placenta, including ST, is a target of PCB toxicity, and that current environmental PCB exposure levels are a risk to reproductive health.

Prenatal spontaneous disruption of the dividing membrane in monochorionic diamniotic twins detected at the time of fetoscopic laser photocoagulation

Spontaneous antepartum rupture of the dividing membrane occurring in monochorionic diamniotic twins (MD twin) is an extremely rare complication and difficult to diagnose prenatally. We present a case of pseudo‐monoamniotic twins derived from an MD twin gestation, which was suspected by ultrasound and was confirmed by antepartum fetoscopy. A 28‐year‐old woman, gravida 1, para 1 at 24 weeks of gestation was referred because of suspected polyhydroamnios in an MD twin. Ultrasound suggested twin–twin transfusion syndrome stage III, spontaneous rupture of the dividing membranes and cord entanglement. Fetoscopic laser photocoagulation (FLP) was performed using the Nd:YAG laser on 12 placental vascular connections. Fetoscopy revealed the spontaneous rupture of the dividing membrane and cord entanglement. The remainder of the pregnancy was managed as a monoamniotic twin gestation. Elective cesarean section was performed at 32 weeks of gestation following antenatal steroids and concordantly grown healthy male infants were delivered.

Successful Management of Pregnancy in a Patient with Systemic Lupus Erythematosus-associated Pulmonary Arterial Hypertension

Pregnancy in women with systemic lupus erythematosus (SLE)-associated pulmonary arterial hypertension (PAH) remains a high risk. We successfully managed a pregnancy in a patient with SLE-PAH. A 31-year-old pregnant woman with SLE-PAH had worsening PAH and SLE flare-up during pregnancy and a sudden increase in pulmonary arterial pressure after delivery. SLE-PAH was controlled by continuous intravenous epoprostenol and inhaled nitric oxide therapy combined with high-dose corticosteroids under close hemodynamic monitoring. Women with SLE-PAH should avoid pregnancy. However, in case of a similar event, we recommend our case as a good reference for improving the outcome of pregnancy with SLE-PAH.